| ABSTRACT Objective：To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability. Methods： From March 2008 to March 2013, 146 patients with unilateral lumbar disc herniation with lumbar instability who need to undergo surgery were enrolled in this retrospective cohort study. Patients were randomly divided into two groups according to osteotomy replantation pattern. There were 77 cases in the traditional group (underwent traditional lamina osteotomy replantation), and 69 cases in the modified group (underwent modified lamina osteotomy replantation). The operation time, blood loss, and complication rate during operation, lamina healing rate, low back and leg pain recurrence rate at three years following operation were recorded. Preoperative and postoperative visual analogue scales(VAS) and Japanese Orthopadic Association (JOA) were recorded。Repeated measures were analyzed by generalized estimated equation (GEE). Results：The operation time and blood loss were similar between two group (P>0.05). There was significantly different in nerve injury rate (5.8% vs. 16.9%) and dural injury rate (1.45% vs. 9.09%) between modified group and traditional group. What is more, significant difference were also found in the recurrent rate of low back pain and intervertebral fusion rate at three year between the two group. GEE analysis showed that modified group exhibited lower VAS score (β= –0.175, 95%CI: –0.263, –0.102; P=0.034), while higher JOA score (β= 0.113, 95%CI: 0.072, 0.191; P=0.017) than traditional group. What is more, the extent of VAS score decreased was higher than traditional group, while the extent of JOA score increased was higher than traditional group. Conclusion: Modified lamina osteotomy replantation has better long-term efficacy (recurrent rate of low back pain, intervertebral fusion rate, VAS and JOA score at three years follow-up) in the treatment of lumbar disc herniation with instability. |
